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When the Diagnosis Is ‘Dead Butt Syndrome’

By Jen A. Miller December 21, 2010 11:42 amDecember 21, 2010 11:42 am

Jen Miller at the finish of the Ocean Drive 10 Miler in Wildwood, N.J.

My butt, unfortunately, is dead.

“Dead butt syndrome,” the sports medicine doctor said to me after making me go through a series of circus-act contortions that involved swiveling my hip in all directions. His voice was very serious, his tone stern. I wondered if I should start making funeral arrangements for my rear, maybe a New Orleans-style blowout parade?

Hold the tuba. My butt’s not really dead. It can’t be revived with defibrillator paddles, but it can be fixed.

The technical name of the condition I have is gluteus medius tendinosis — an inflammation of the tendons in the gluteus medius, one of three large muscles that make up the butt. It’s a very isolated and painful injury that knocked me out of marathon training in January with stabbing pains in my hip. It’s a symptom related to what running experts hammer at: the need for cross-training and strength training. I was running so much that I told myself I didn’t have time for the exercise machines or weights, so I have no one to blame but myself.

I’ve been running for five years, but I’d never heard of the problem. I ran it by a friend, a former track coach at the University of Pennsylvania, and he was baffled too. I haven’t seen any coverage, though the doctor said it’s fairly common with runners who train for half marathons and beyond. It took him five minutes to figure out the problem.

“A new thought in running medicine is that almost all lower extremity injuries, whether they involve your calf, your plantar fascia or your iliotibial band, are linked to the gluteus medius,” said Dr. Darrin Bright, a sports medicine physician with Riverside Methodist Hospital in Columbus, Ohio, and medical director of that city’s marathon. “In the last five to 10 years, we’ve just realized how much of an important role the gluteus medius plays in stabilizing the hips and the pelvis in running.”

If you think of the pelvis as a cup, the muscles that attach to it, including the three gluteal muscles and the lower abdominals, interact in an intricate choreography to keep the cup upright when you run or walk. If these muscles are strong, the cup stays in place with no pain. If one or more of those muscles is weak, the smaller muscles around the hip take on pressure they weren’t designed to bear.

The cup still stays up, but at a price. First come muscle tears and inflammation, followed by scar tissue in the muscle. If left untreated, this process becomes a cycle that keeps feeding into itself.

Some of us run through the pain, which is what I did. And many compensate by adjusting their strides in a way that impedes the gait and can lead to problems in the quads, hamstrings, Achilles tendons, heels, knees, calves, ankles, feet or toes.

“Whether they’re recreational weekend runners up to the elite marathoners, the majority of runners I see have weak gluteus medius and gluteus maximus muscles,” said Dr. David Webner, a sports medicine doctor at Crozer-Keystone Health System in Springfield, Pa.

For about 70 percent of his patients, physical therapy that stretches the muscles in the hip and leg and strengthens the gluteus muscles, along with a temporary reduction in the mileage and intensity of running, resolves the problem. Deep tissue massage, which sends more blood to the area to break up scar tissue, along with strength training may also help to break the cycle of inflammation and scarring.

More advanced approaches include ultrasound guided tenotomy, which uses ultrasound to identify the affected muscles and then “poke little holes in the area of the scar tissue,” Dr. Webner said, or platelet-rich plasma therapy, which involves injections of centrifuged blood products and is what Tiger Woods underwent after knee surgery last year.

Fortunately, I didn’t need to take it that far. I’m lucky — the pain has ebbed with physical therapy and changing one of my weekly runs to a cross-training workout.

“Those runners who do multiple types of exercising are less prone to have weakness than runners who do just running,” said Dr. Webner. “Triathletes who come into my office don’t have as much weakness as just solo runners.”

So I’m biking. I row. I sweat through elliptical workouts at the gym.

And I no longer have the feeling that a pin is stabbing my hip every time I drive. I can sit for more than a half hour without pain. And last month I ran the Amish Bird-in-Hand half marathon, and felt no more discomfort than you’d expect to endure running 13.1 miles through the hills of Pennsylvania Dutch country.

To keep my rear alive, I must be vigilant about continuing to strengthen my lower abdominal and gluteal muscles. Last week, I slacked off and the pain came creeping back.

Is it annoying to have to focus so much on these muscles to run? Absolutely. But if it’ll revive my butt, it’s worth every leg lift and crunch.

Despite the funny name of this syndrome I love the message it sends — even if we’re active we need to consciously strengthen the lower body in order to be free of hip/leg/knee pain. I’m not an avid runner but doing daily squats has been revolutionary for me!

Great article! I’m a runner who’s had several injuries in the last year – Achilles tendon tear and now high hamstring & piriformis pain. I’d love to know what kinds of strengthening exercises Jen did to strengthen her glutes and “resuscitate her butt”.

Question for anyone who might know: is this true for any exercise done exclusively? In warm weather, I can run, bike, walk, and do the elliptical for aerobic work-outs, but in the winter, it’s just the elliptical for me. I do lift weights as well. Does doing the elliptical every day instead of mixing it up with the other forms of aerobic exercise have the same “dead butt” effect?

Marathon training can be harmful in that it forces the muscles of the lower body to conform to a shorter gait than that which the body evolved.

You can see this if you ask a person who can run for hours on end to try sprinting across a field for just a few seconds – they simply can’t do it. The muscles and ligaments needed to increase stride length and bring the knee to waist level have deteriorated or become too stiff.

Forcing yourself to run at a faster pace or interval training on a grassy field can strengthen all the muscles of the leg and butt.

All of us, addicts athletes do not pay enough attention to the signs of warning that our body signals as we believe that our body would not betray us. It happens to everyone eventually one way or another.
http//www.lifestyle-after50.com

I can’t help but wonder if the wrong lesson, or perhaps only half of the right lesson, is being learned here. Where Ms Miller writes “To keep my rear alive, I must be vigilant about continuing to strengthen my lower abdominal and gluteal muscles,” I suspect she’s on the right track with cross training, but should expand her focus to all her core muscles, not just the lower abdominals.

It seems that moderation and variation are key components in preventing, or reversing this posterior paralysis. Moderation and variation seem to be a running theme over the course of time that has proven to achieve balanced health.

The article might have mentioned another method that may mitigate the development of “Dead End Syndrome”.

The “Rosie Ruiz Method”. By employing this method, one will preempt the possibility of Dead Butt.

Remember Rosie? Boston Marathon 1980? She won! Sort of. Best time ever recorded for a woman marathoner. How did she do it?

“Ruiz had dropped out of the race, hopped on the subway, got off about a mile from the finish line, and ran in from there.” (No Gluteus Maximus stress)

“Other observers noticed that Ruiz wasn’t panting or coated in sweat, and her thighs were much flabbier than would be expected for a world-class runner.” (Her gluteus situation may have been functioning properly… but her thighs!)

One disgruntled runner told Rosie Ruiz that she didn’t look tired enough to have run 26 miles–so she hit him with her roller skate!
–Mark Russell, WRC radio

Rosie Ruiz was disqualified from the Boston Marathon today. Officials became suspicious when she crossed the finish line of the 26.2 mile event wearing open-toed sandals and smoking a cigarette.
–ABC TV “Friday” show

Rosie Ruiz is taking this too seriously. Instead of crying on national TV, she could have written a book, Shortcuts to Fame. It would start on Chapter 20.
–David Kindred, Washington Post

Now Rosie Ruiz can be just like Bill Rodgers, and sell her own line of running gear. Rosie Ruiz shoes–so comfortable that when the marathon is over your feet feel like they’ve only gone a mile or two.
–David Kindred, Washington Post

So, moderating your run with the intermittent subway ride not only reduces the possibility of developing Dead Butt Syndrome, it gets you to the finish-line more expeditiously.

We have now arrived at the clear understanding that everyone is at risk for something and that everything now has a name, actually a diagnosis, for something else.

We have a test, a pill, and inclusion about almost all the major illnesses, diseases and injuries and a general understanding that modern medical care received in America is one of the leading killers.

Now along with worrying about the demise of Social Security, Medicare, any sense of social responsibility to others. (We do not need to worry about our own jobs, job security, decent pay, adequate benefits or retirement as these have mostly been lost to the middle class and for longer to the poor.)

Now we can start worrying constantly about syndromes and our health, our risk factors and the many drugs foisted on us and disbelief that worrying, those tests and pills in of themselves are killing any value to life and life itself.

And in case we miss the point we can just watch TV and see endless advertisements of what we should worry about, and how the pill being advertised is right there for us if we would only get our fat butts off the couch long enough to get to the doctor. The doctor has already been prepped by the drug companys’ representatives to prescribe and reap the rewards.

So off those dead butts, make the call and drag that dead butt off to be drugged. Anyone stupid enough to not act now is worse than a dead butt. They are just (jack)asses!

I trained for my first marathon this year (having run shorter distances for 30 years), and, while no one gave it a name, this sounds like what happened to me. I was in pain and limping. I needed treatment. Some combination of rest and five or so different core and glut’ strengthening exercises have me again walking and running without pain.

After I sprained my muscles weight training for strength, I blamed the training itself – I had exercised to the point of failure and the free weights simply decided to go where my exhausted arm muscles didn’t want to go. After this episode, even lifting a tooth brush, a fork or a pair of chop sticks required willlpower and focus :)

I have been training for endurance rather than strength for several months so far, going for lower weights but aiming to achieve high repetitions (say 50). I am using free weights which are more likely to work out all muscle groups than the weight machines. And I am, of course, staying away from the weight machines. I believe in working all muscle groups, and I don’ t care if any trainer disagrees. From my perspective, working all muscle groups reduces the probability of injury and if there is one thing I dislike, it is getting injured. In addition, working on my endurance allows me to build the muscle fiber over time – the muscle fiber builds itself up on its own schedule not mine. I found out the hard way that training from strength allowed me to lift heavier weights faster than either my existing muscles or my bones structure could take. Not a good thing.

Ideally, I should work on both endurance and strength. But since I work full-time and more, I cannot do everything within the time budgeted and I do have to make a choice. Endurance it is.

So far, it’s working very well. Yeah, don’t look like Arnold Schwrazenegger but then most Navy Seals don’t look like musclemen. And I DON’T want to look like Arnold Schwarzenegger: Not in my line of work where I am expected to know how to use my brains, and I have to look like it :) But the best part is that I didn’t get hurt again :)

The best bet is to do some good ol’ fashioned squats and deadlifts. No other exercises are as good for the lower body as those two are. And do some real strength work and your legs and butt will certainly appreciate it.

I’ve trained for marathons and ultras with an emphasis on strength training and have not had any serious or chronic injuries. I suggest that all endurance athletes do pure strength work regularly.

Although it may not sound like much compared with intense cardio-workouts, tai chi is one of the best exercises available for working all core and lower extremity muscles. If you think it’s only for wimps or the elderly, try a couple of months at a martial arts school. We regularly have black belts from other disciplines, and runners, who are amazed to discover they have to learn to use muscles they weren’t aware they had. And, beautifully, tai chi is infinitely adaptable to recovering from injury.

TAke a tennis ball or hard rubber ball, lie on the floor, put it under your butt, your own body weight provides the pressure, find that sore area, hold it for a little bit, move the ball and find another sore area, and keep repeating. Do this as often as possible. A lot of problems in the butt are due to trigger points in the muscles, and using a ball in this way helps release those trigger points, which is what a deep tissue massage will do. There might also be trigger points in the gluteus maximus, gluteus minimus, and piriformis. Just poke around until you find those sore points which paradoxically also feel good when pressure is applied to them. It is a lot cheaper than spending big bucks with the physical therapist or orthopedist.

An important subject that deserves attention. Often the problem is resolved after Dry Needling of the gluteal and related trigger points, massage to remove adhesons and appropriate exercises.

Dry Needling involves using an acupuncture needle in the triggerpoints and does not need anesthesia. The acupuncture needle can be used at the area of tendinopathy as well.

This is a safe, low tech approach that is standard of care here in Europe. The technique is also wide spread in Canada, Austrailia, and New Zealand. It is provided by chiropractors, physical therapists, and increasingly medical doctors. But not in the U.S., where for political reasons there are only 5 states in the U.S. that allow dry needling to be done by non physician and non acupuncture providers.

Some east coast acupuncture schools are teaching approaches to triggerpoint dry needling as well, but while the thin acupuncture needle is used, the technique is based on western diagnostic principals, science, the work of Travell and the science of tendinopathy. Here in Norway acupuncturists often refer patients out for the procedure for this reason. The Well Blog staff should explore dry needling (also called IMS intra muscular stimulation), and why it is not being used more in the U.S. as a matter of public health.

While you have likely determined the tissue that is irritated, you have not attempted to figure out the biomechanical dysfunction that created the increased stress on that tissue in the first place. While deep tissue massage might be a short term relief, it is important to normalize any restriction at the lumbopelvic hip region and restore normal biomechanics. It is nice to see someone relate hip dysfunction to other lower extremity pathology such as patellofemoral pain syndrome.

Just requested a referral to PT yesterday from my doc, for the problem described by the author. I am a daily 3-4 mile runner, not a marathoner, and 1 year ago endured a protracted recovery from a hip flexor injury. The PT was a great help, and I have been religious in routine stretching for the first time in my life, but suspect that my attention to the first injury led to some type of overcompensation which permitted the second injury…the “dead butt” pain is 180 degrees from the hip flexor pain.